You may have health
insurance or a health
plan that pays for all the care you need. Or it may pay for some of what you need, but
not all. Or you may have no health insurance or plan.

Sadly, we are not guaranteed a right to health care in the United States. Someone has
to buy it. It could be your employer, the government, or you. It is important to
understand your health plan so you can be sure your plan is paying for everything it
should.

What if you have no insurance? There are ways to get free and low-cost services.

What You Can Do:

If you have health insurance, learn how it works.

Many of us feel that our health plan should pay all the costs of our health problems.
But health care is like car insurance or home insurance. There are different packages and
types of coverage.
Your plan may not pay for all the health care you need or want. You need to learn about your
health plan package.

Find out who pays for your health plan.

Most American adults under age 65 get their health insurance through their jobs.
Employers may pay for all, some, or no health insurance costs. There is no law that
says employers must provide health insurance to their employees.

Other adults buy health insurance for themselves. For example, self-employed people
usually buy their own insurance.

Most Americans age 65 or over can get health insurance through the federal Medicare program. The
federal-state Medicaid
program covers mostly lower-income families and people with disabilities. The rules for
getting Medicaid vary by state.

Your health insurance "carrier" is the company that carries out your health
plan's rules. It is also the company that pays for your care. Blue Cross and Blue Shield
is an example of a health insurance carrier. When your insurance carrier pays for
something, it is called a "benefit."

Are you disabled? Will your disability last six months or more? If so, you may be able
to get disability benefits from the federal government through the Social Security
Disability Insurance (SSDI) program.
The government usually agrees that you are "disabled" if you have metastatic breast
cancer (breast cancer that has spread to another organ in your body).
Are you under age 65? And have you gotten SSDI benefits for at least 24 months? Then you
can also enroll in Medicare. Contact the Social Security Administration (SSA) and Medicare program for
more information.

Do you earn very little money? You may be able to get Medicaid. Contact your state's
health department. The phone number should be in the government pages of your phone book.
Someone there can tell you if you can get Medicaid. He or she can also tell you which
benefits your state offers.

Some health insurance plans require you to pay a portion of the health care costs. This
is called a copayment.
There are several nonprofit groups that have copayment assistance programs for individuals
with certain diagnoses. The Patient
Advocate Foundation has a Co-Pay Relief Program for individuals with breast cancer,
and a group called CancerCare
is able to provide some copayment assistance for breast cancer oral drugs.

Several nonprofit groups provide copayment assistance for chemotherapy-related
diagnoses including abnormally low levels of white blood cells (neutropenia), abnormally
low levels of red blood cells (anemia), and nausea and vomiting. Among these groups are
the Patient Access Network
Foundation, Patient
Services, Inc., and the HealthWell Foundation. Contact
these groups to see if you are eligible for financial assistance with your copayment.

If you don't have health insurance, look for free or low-cost services.

Contact breast cancer activists in your state.

NBCCF's field coordinators work closely with NBCCF's national office. They know about
the services you can get in their areas. And they can connect you with others who have
been down the same road. Contact NBCCF to see if there's a field
coordinator near you.

Find out if you can get screened at a CDC site.

The U. S. Centers for Disease Control and Prevention (CDC) runs the National Breast and
Cervical Cancer Early Detection Program (NBCCEDP). The program has a long name, but a
simple and important task. It gives breast and cervical cancer screenings and
treatment to low-income women. All 50 states offer screening and diagnostic services through
the NBCCEDP.

NBCCF worked hard to pass the Breast and Cervical Cancer Treatment Act in 2000. The Act
expands the NBCCEDP. It allows states to give treatment through the Medicaid program. Now,
if a woman gets a mammogram
through this program, and it turns out she has breast cancer, the NBCCEDP can pay for her
treatment, too. And as of May 2004, all 50 states and the District of Columbia have passed
legislation to provide free treatment through the program, too.

To get breast cancer care through the program, you must:

get your mammogram through the CDC NBCCEDP and need treatment for breast cancer (You
qualify if your mammogram shows a preinvasive condition, too),

Check if your state offers its own cancer screening and treatment program.

A few states have health care programs for people without insurance. Contact your state
health department to see what services your state offers. The phone number should be in
the government pages of your phone book.

Learn about the Hill-Burton free care program.

In 1946, Congress passed a law called the "Hill-Burton Act." It gave
hospitals and other care centers money for building and updating. In return, the centers
that received these funds agreed to:

provide a reasonable volume of services to people who can't pay and

make their services available to all people living in the center's area.

This means that many care centers must give health care to some people who can't afford
to pay. To qualify for free care, your income must be below a certain level. And, you must
not be covered by Medicare or Medicaid, or some other health insurance program. You can
apply to the program at any time. You can apply before or after you receive care. You can
even apply if a bill has been sent to a collection agency. If you qualify, Hill-Burton
funds will cover the care center's charges. It doesn't cover your private doctor's bills.
Still, this can be a huge help.

Hill-Burton care centers must post a sign that says, "NOTICE - Medical Care for
Those Who Cannot Afford to Pay." This sign must be posted in the care center's
Admissions Office, Business Office, and Emergency Room.

Here's how to find out if you can get free care through the Hill-Burton program:

After you find a Hill-Burton care center, go there and ask for a copy of its
"Individual Notice." This notice will tell you which types of free or low-cost
services the care center provides through the Hill-Burton program. It will also tell you
where in the care center to apply to the program.

Apply to the program. Usually, you must go to the Admissions Office or Business Office
to apply. The care center may ask you to fill out an application.

If you are asked for proof of your income, give this information to the care center. A
pay stub may be requested.

If you are asked to apply for Medicaid, Medicare, or some other financial assistance
program, you must do so.

When you return the completed application, ask for a "Determination of
Eligibility." This will tell you whether you can get free care through the program.

Contact a local or state health services group.

Many local and state groups give free or low-cost mammograms and other health services.
For example, the Avon Breast Care Fund gives money to many community groups. These groups
give free or low-cost mammograms to women without health insurance. Contact the Avon Breast Care Fund to
find out what is in your area.

Find other ways to get help paying for care.

Look for groups that can help pay for care. The nonprofit group CancerCare has a booklet
called, "A Helping Hand Resource Guide." It lists cancer-related assistance
programs available across the country. Ask the group to send you a copy.

The Georgetown University Health Policy Institute has Consumer Guides for Getting
and Keeping Health Insurance, available for all 50 states and the District of Columbia
through its Healthinsuranceinfo.net
Project. These Consumer Guides describe your health insurance rights and
protections,and provide a listing of state and federal resources for financial assistance.

Ask for free medicine.

Ask your doctor or nurse about "drug assistance programs." Some drug
companies give free medicine to patients who can't pay for it. Every drug company has
different rules. These programs don't include all drugs. But they're worth looking into.
Your doctor or clinic may have access to these programs. The drug companies have a group
called Pharmaceutical
Researchers and Manufacturers of America (PhRMA). PhRMA has information on all the
drug assistance programs their members offer. Contact PhRMA to see if a drug company can
help you.

Ask for help getting to and from your treatment center.

Your NBCCF field coordinator may know about ride services in your area. Contact NBCCF to see if there is
a field coordinator near you.

You can ask doctors, nurses, and social workers about services that can help you.

Local groups may also have information. Try cancer organizations, community centers,
churches, temples, and women's groups. Sometimes they can give you free or low-cost rides
to your doctors' offices or to hospitals.

The Patient
Travel organization has free information and referrals. The group helps people who
must move far away for care after an illness or accident. Contact Patient Travel for more
information.

Ask everyone for help.

Ask people to hold fund-raisers for you. Or talk with leaders of your religious group.
See if they can help you cover the costs of your care.

Contact your local, state, and national elected public officials. (Some examples are
mayors, state representatives and senators, and U. S. representatives and senators.) They
may be able to help you.

Go to your local hospital. Explain your problem to a doctor, nurse, or social worker.
They know the system. They may be able to direct you to the right place for help.

Get time off work.

The Family and Medical Leave Act (FMLA) lets people take time off from work. People use
the time to care for their families or themselves without losing their jobs. Do you work
for a company with more than 50 workers? If so, you can take up to 12 weeks of unpaid
leave a year. The leave can be used to:

There are also programs that may help women with metastatic breast cancer if they want
to retire from work. Women with metastatic breast cancer may be able to get Social
Security Disability Insurance (SSDI). SSDI gives money to women who qualify. Contact the Social Security Administration
for more information.